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Health outcomes and provider choice under full practice authority for certified nurse-midwives

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  • Hoehn-Velasco, Lauren
  • Jolles, Diana R.
  • Plemmons, Alicia
  • Silverio-Murillo, Adan

Abstract

Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008–2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Suggested Citation

  • Hoehn-Velasco, Lauren & Jolles, Diana R. & Plemmons, Alicia & Silverio-Murillo, Adan, 2023. "Health outcomes and provider choice under full practice authority for certified nurse-midwives," Journal of Health Economics, Elsevier, vol. 92(C).
    • Handle: RePEc:eee:jhecon:v:92:y:2023:i:c:s0167629623000942
    DOI: 10.1016/j.jhealeco.2023.102817
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    More about this item

    Keywords

    Scope of practice; Full practice authority; Occupational licensing; Maternal health; Infant health; Certified nurse-midwife; Consumer safety; Affordable Care Act;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • K0 - Law and Economics - - General
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations

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